Challenges of care during a pandemic

The following challenges can become more evident during lockdowns and after the declaration of a pandemic in the UK.

Nutritional care, particularly nutrition support, is essential for improving outcomes in people at risk of malnutrition during COVID-19 recovery.

People who have not had the virus may also require nutritional care and access to specialised services. Delivering this care during a pandemic, especially with restricted face to face consultations, can be difficult. The following points should be considered.

Raising awareness 

There is a lack of awareness (particularly across vulnerable groups and ethnic minority groups) about support resources available across the UK. Some potential solutions for providing nutritional information and advice during a pandemic include:

• weekly newsletters sent out with a COVID-19 related topic
• to confirm via telephone or multidisciplinary team meetings, matrons, lead nurses
• posters in GP surgeries and other healthcare facilities
• include useful links and resources on hospital discharge letter, where appropriate.  
• to increase levels of resourcing on wards
• peer learning support and research (Lawrence et al., 2021)
• to supply training on how to support clinicians on post COVID-19 symptoms and longer-term impacts on nutritional management
• to increase networking at an organisational level
• to recognise unpaid carers and how their feedback can improve health and social care – more information can be found on the Care Quality Commission website
• The British Dietetic Association also has advice for the general public in relation to COVID-19 as well as a range of 'Food Fact Sheets' providing advice and information about diet and nutrition on a range of conditions and nutrients

Food and nutrition security

Recommendations for improving food and nutrition security include (Carducci et al., 2021):

• Trigger effective government investments in small and medium-sized enterprises (as well as gender-sensitive and gender-transformative), including support to workers through social innovations and employee health programmes
• Invest in nutrition literacy approaches and policies to increase demand for nutritious foods
• Strengthen social protection programmes (promote cash or vouchers for nutritious food markets) and enable safe trade corridors for nutritious foods
• It is key to activate local and governmental actors, as well as to create partnerships and bring international partners to translate these recommendations
• The British Dietetic Association has information on food poverty and insecurity
• A major review of the impact of lockdowns in African countries on nutrition and food security has been completed to highlight learning for future use of lockdown procedures. The results highlight both the need and scope to design nutrition-sensitive lockdown strategies, which are effective from an epidemiological perspective but minimize trade-offs with food and nutrition security. There may be some learning from this for Western countries too (Daum et al., 2020 [PDF])

Improving the continuity of care during a pandemic

Enabling staff to provide nutritional support can be challenging in a pandemic when staff shortages and stress among others are a daily issue. The following provides guidance to overcome those challenges.

• Review the process of care you are using to assess what approaches to support COVID-19 recovery work and why
• Consider all elements of the pathway and any resource requirements and what organisational approvals are needed
• Clear governance structures which approve and develop decision-making and ownership in the organisation are useful 
• Involvement of the MDT is important and training around nutrition and nutritional care may be needed
• Transition to different care settings can be a challenge for continuity of care; assess how this transition will be managed
• Updating GPs and/or community services with aspects of care provided in acute settings is advisable to avoid duplication of effort or failure to pick up patients. (Lawrence et al., 2021)
• Assign clear responsibility for follow up. For instance, some responsibility for monitoring nutrition can be delegated to physiotherapists, nurses, pharmacists, and so on. Training may be needed
• A system thinking approach can be helpful but requires learning how to triage from the first phone call. (Carson et al., 2021; Lawrence et al., 2021)
• Resistance to policy change can be challenging and training may be needed to help resolve it
• There is a risk of potential overlap of services in acute and community settings. Clarity and agreement on responsibilities is needed
• COVID-19 increases the risk of malnutrition so consider facilitating training packages for primary care, social services and third sector agencies to identify when people need nutritional support through malnutrition screening

For more examples of good practice for nutritional care see BAPEN and British Dietetic Association (BDA) websites.

Consider the patients’ perspectives

• Aim to work in partnership with patients to address their needs
• Provide patients with clear information on pathways of care, and advice on how to seek help from health care professionals to tailor health goals
• Helping patients to identify reputable information online and in social media channels may be particularly important in the context of telehealth (see our page on Understanding the Evidence)